tbuckley/cabot-search huggingface dataset:
Abstract P628: The Right Dose for the Right Patient - High Intensity Rosuvastatin Dosing in Patients With Chronic Kidney Disease
Authors: Edan Zitelny, Robert Hickey, Monika Sanghavi
Journal: Circulation (2023)

Introduction: The utilization of high intensity statins for lipid lowering therapy has revolutionized our approach to decreasing the incidence of myocardial infarction. In February 2003, rosuvastatin was approved by the FDA for use at dosages ranging from 5mg to 40mg daily, with lower doses recommended for patients with reduced glomerular filtration rates (GFRs). Prescribing patterns of rosuvastatin for patients with chronic kidney disease (CKD), notably those with a GFR &lt; 30 mL/min/1.73m 2 , is largely unstudied. Methods: A single center retrospective study of all admitted patients with a chart diagnosis of chronic kidney disease (CKD) over the course of one year was performed. Data on inpatient rosuvastatin orders and overall statin selection was collected and analyzed. Results: Between 10/1/2021-10/1/2022, a total of 5359 patients were admitted with the diagnosis of CKD. In this cohort, 62% (n = 3325) had a prescription for a statin placed for continuation of outpatient care or new initiation of lipid lowering therapy. Most patients were on atorvastatin (69.4%, n = 2310) or rosuvastatin (20.9%, n = 695). Among inpatients with CKD, a total of 1465 inpatient rosuvastatin orders were placed. Almost 32% (n = 468) of these patients had an eGFR &lt;30 mL/min/1.73m 2 . Of this cohort, 48% (n = 223) were prescribed doses of 20mg or 40mg rosuvastatin daily, which is above the FDA recommended dose for this population ( Figure 1 ). Conclusions: A large percentage of patients on lipid lowering therapies have CKD, and data regarding renal outcomes associated with high doses of statins in this population are limited. In this large single center study, we found that nearly half of patients with eGFR &lt;30 mL/min/1.73m 2 were on inappropriately high doses of rosuvastatin when considering their kidney function. Further research into long term outcomes and rosuvastatin dosing in this patient population is needed.
Abstract P504: Prospective Associations of Midlife C3, C4 and Their Changes Since Midlife With Future Cognitive Performance: The Study of Women’s Health Across the Nation HDL Ancillary Study
Authors: Meiyuzhen Qi, Maria M Brooks, Imke Janssen, Dan McConnell, Emma Barinas-Mitchell, Carol Derby, Arun Karlamangla, Sybil Crawford, Trevor Orchard, Jeffrey Billheimer, Samar R El Khoudary
Journal: Circulation (2023)

Objective: Almost two-thirds of Americans over 65 with Alzheimer’s disease (AD) are women. The menopause transition is characterized by a systemic inflammatory state which increases atherosclerosis risk predisposing to dementia. Complement system was inappropriately activated in the brain of AD patients, which may contribute to local inflammation correlated with cognitive dysfunction. Complement factor 3 (C3) and 4 (C4) are the most clinically used complement components. Increased serum C3 and the presence of C4 null genes producing less C4 are risk factors of cardiovascular disease (CVD), indicating the necessity of analyzing the ratio of C3 and C4. Since serum C3 and C4 markedly increase over the menopause transition, we aimed to assess the associations of midlife C3, C4, and C3/C4 ratio and their changes since midlife with future cognitive function in women. Design: Repeated measures of serum C3, C4, and measures of working memory (digit span backward test), processing speed (symbol digit modality test), episodic memory immediate and delayed recall (East Boston memory test) were evaluated among midlife women traversing menopause. Mixed effect models were applied to assess the associations. Results: We included 305 women (706 observations) with mean age of 51 (SD=3) and 72% of them being pre- or perimenopausal at baseline. C3 and C4 were measured a median of 1.07 (Q1: 0.94, Q3: 1.81) years before cognitive performance assessment. In final models, higher C4 measured at midlife (baseline) was associated with better future episodic memory levels, and higher midlife C3/C4 ratio was associated with worse future episodic memory ( Table ). Changes in the complement factors were not associated with cognitive measures. Conclusion: Among women, higher midlife C4 and lower midlife C3/C4 ratio, but not changes in C4 or C3/C4 ratio since midlife, were associated with better future episodic memory levels. Midlife complement protein levels could be early markers of cognitive impairment known to be linked with CVD.
Abstract P658: Redlining, Neighborhood Vulnerability, and Heart Failure Outcomes Among Patients in the Southeastern US
Authors: Nicole D Fields, Andrea Tristan, Alanna A Morris, Shivani A Patel
Journal: Circulation (2023)

Introduction: Disparities in heart failure (HF) outcomes are due, in part, to social determinants of health. Structural racism is thought to be a fundamental cause of health disparities. A form of structural racism, redlining, was instituted in the 1930s to disinvest in neighborhoods with a high concentration of racial and ethnic minorities, leading to neighborhoods marred by crime, poverty, and disrepair. While studies have focused on how the contemporary neighborhood impacts health outcomes, few studies have examined how historical racist policies have shaped cardiovascular disease outcomes. Additionally, no studies have focused exclusively on the Southeastern region of the US where rates of cardiovascular disease and HF are among the highest in the country. This analysis examined the association between redlining and HF outcomes (e.g., 30-day readmission and mortality) among HF patients residing in Georgia. Hypothesis: Patients residing in “definitely declining” and “hazardous” neighborhoods will have a higher risk of both 30-day readmission and 30-day mortality compared to patients residing in “best” defined neighborhoods. Methods: Data are from a retrospective cohort of patients hospitalized for acute HF within Emory Healthcare from 2010 to 2018. Patient addresses were geocoded and linked to historically redlined neighborhoods at the census tract level using Home Owners’ Loan Corporation (HOLC) maps which classified neighborhoods as: “best”, “still desirable”, “definitely declining”, or “hazardous/redlined”. Neighborhood deprivation was assessed at the census tract level using the Social Vulnerability Index. Multivariable logistic regression was used to estimate the relative risk of 30-day readmission and 30-day mortality across HOLC-graded neighborhoods adjusted for patient demographics, clinical and hospital characteristics, and neighborhood deprivation. Results: Within the full sample, redlining was not associated with either 30-day readmission (RR 0.90; 95% CI: 0.62, 1.31) or mortality (RR 1.32; 95% CI: 0.79, 2.20). Redlining was not associated with 30-day mortality among Black patients. However, residing in a historically redlined neighborhood appeared to be associated with a two-fold increased risk in 30-day readmission for Black patients although results were non-significant (RR 1.98; 95% CI: 0.52, 7.59). Conclusion: In conclusion, redlining was not associated with HF readmission or mortality across racial groups. Findings among Black patients suggest that redlining may be associated with adverse heart failure outcomes. Further research with larger samples is needed.
Abstract P511: Physical Activity, Medical, and Mental Health Outcomes of a Pilot Multilevel Intervention for People With Metabolic Syndrome
Authors: Rachel A Millstein, Lauren Harnedy, Anne N Thorndike, Sonia Kim, Crystal Castillo, Elyse R Park, Brian C Healy, Jeff C Huffman
Journal: Circulation (2023)

Background/Objectives: This pilot randomized controlled trial aimed to help people with metabolic syndrome increase physical activity and well-being. Intervening on lifestyle behaviors such as physical activity, can improve metabolic syndrome outcomes. Methods: Primary care patients with metabolic syndrome were recruited from clinics across our hospital system. Eligibility criteria were: &lt;150 minutes/week of moderate-vigorous physical activity (MVPA), having ≥2 of 5 metabolic syndrome criteria, and not having cardiovascular disease or diabetes, as this was a prevention study. The multilevel intervention (MAPP) included 8-weekly 60-minute group sessions, physical activity self-monitoring/goal setting using Fitbits, physical activity/motivational interviewing (MI) topics, positive psychology (PP) topics, a weekly group walk prior to COVID, and neighborhood walkability assessments. Participants were randomized to an immediate or waitlist control group. They wore an Actigraph GT3X+ accelerometer for one week before beginning and after the last session (8-weeks). We obtained pre-post weight measurements. Mean baseline to 8-week individual difference results were compared between groups using t-tests with unequal variances. Results: Sixty-four participants enrolled, with 32 randomized to each arm; 51 provided complete follow-up data, and 63% (10/16) of the groups were conducted virtually (post-COVID). Most (92%; 59/64) were non-Hispanic White, 69% (44/64) were female, and mean age was 60. Average daily physical activity did not increase significantly by objective measures. The estimated change in mean difference for sedentary time decreased for the intervention group compared to the control group by 46.8 minutes/day (CI: -47.5-141.1; d= 0.28). Light physical activity increased by an average of 21.0 minutes/day (CI: -13.9-55.9; d= 0.34), steps/day increased by 376.6 (CI: -949.6-1702.9; d =0.16), and moderate-vigorous physical activity increased by 4.1 minutes/day (CI: -4.5-12.8; d=0.27). The estimated change in mean weight was significant: 8.4 pounds lost for the intervention group compared to the control group (CI: -13.5-3.2; p =.002; d =0.92). Discussion: This 8-week randomized controlled trial of a multilevel physical activity PP-MI intervention was associated with small to medium effect sizes for changes in physical activity, and a significant decrease in weight, despite weight not being an intervention target. Changes of this magnitude are associated with reduced cardiovascular disease risk and mortality. These findings are all in expected directions, producing signals even amidst different modalities and COVID-19-related disruptions. We plan to test this in a larger efficacy trial with broader reach and implementation.
Abstract P637: Sex-Specific Population Attributable Fractions to Cardiovascular Mortality Among US Adults
Authors: Ling Tian, Siyi Geng, Byron C Jaeger, Kirsten Dorans, Jing Chen, Jiang He, Joshua D Bundy
Journal: Circulation (2023)

Background: Previous studies suggest that prevalence and associations of metabolic risk factors with cardiovascular disease (CVD) differ between women and men. However, few studies have investigated the simultaneous contributions of social, behavioral, and metabolic risk factors to CVD mortality for women and men in a US nationally representative sample. Results of this study could aid researchers, clinicians, and policymakers in developing precision strategies to reduce the burden of CVD. Hypothesis: Metabolic risk factors contribute to CVD mortality more in men than women, and social determinants of health (SDOH) and behavioral risk factors contribute to CVD mortality more in women than men. Methods: We included 50,808 participants aged ≥20 years from the National Health and Nutrition Examination Survey 1999-2018, linked to the National Death Index for cause-specific mortality follow-up through December 31, 2019. Social determinants of health and behavioral and metabolic risk factors were collected in each survey cycle. CVD mortality was ascertained by ICD-10 codes I00-I09, I11, I13, I20-I51, and I60-I69. We estimated the simultaneous impact of social, behavioral, and metabolic risk factors on CVD mortality in women and men using average population attributable fractions, which consider both the prevalence and strength of association of all risk factors in one model. Results: During a median 9.0-year follow-up, 2,589 CVD deaths were recorded (1,140 in women; 1,449 in men). Current smoking, hypertension, diabetes, and albuminuria contributed to CVD mortality significantly among both women and men. SDOH, behavioral and metabolic risk factors contributed 11.2%, 9.0%, and 30.2% to CVD mortality among women, but 9.6%, 7.4%, and 33.9% among men (Table). Conclusions: Social and behavioral risk factors have a larger role in population-level CVD mortality among women, while metabolic factors play a larger role in men. However, overall population attributable fractions of CVD mortality were similar in women and men.
Abstract P632: The Ballana Heart Study: Preliminary Results
Authors: Marina Sous, Esraa Magdi, Nagwa Ebrahim, Irini Samuel, Alaa Afify, Montasser Ahmed, Mahmoud AbdelNasser, Soha Hekal, Shehab Anwer, Mo’mena Tawfiq, Sherouq Elias, Manar Osman, Basma Shenouda, Abdullah Nouri, Amira Rateb, Arwa Mohamed, Mohamed Salah, John Locas, Eslam Abdelaziz, Dalia Shash, Dina Osama, Mohamed Zakaria, Ahmed M Elguindy, Yasmine Aguib, Magdi Yacoub
Journal: Circulation (2023)

Introduction: There are considerable ethnic variations in the incidence and severity of cardiovascular diseases (CVD). To date, there have been very few studies from Africa and the MENA region and none that have focused on CVD. Ballana Heart Study (BHS) is a prospective cohort study of Egyptian Nubian population who live in the Ballana village (29,000 inhabitants) in the south of Egypt. Aim: Defining the cardiovascular phenotype, genotype and risk factors combined with follow-up visits for 30 years. Methods: Participants ≥18 years old after consenting go through a series of stations. A fasting venous blood sample is collected for diagnostic, genetic, molecular biomarkers testing and biobanking. Followed by a detailed questionnaire on demographic characteristics, anthropometry, vital signs, CVD risk factors and family history. Detailed clinical phenotyping including ECG, and Echocardiography. Follow-up visits and/or phone interviews occur every 1-3 years depending on their severity risk for a period of 30 years. Participants with evidence of CVD are referred to the Aswan Heart Centre for management. Results: A random sample of 1,200 representative households was obtained from official government bills. To date, 549 households were analyzed. The preliminary findings in the first 2000 participants showed a mean age of 46 years (62% females). The rates of consanguinity between spouses and parents were 45% and 39% respectively. Seventy percent were either obese or overweight (BMI ≥30 kg/m 2 .), 65% had LDL ≥ 100 mg/dL and 37% reported a family history of CVD. Investigation showed diabetes (23%), hypertension (20%), ischemic heart diseases (3.5%), only 15 patients (0.8%) had echocardiographic evidence of rheumatic heart disease (RHD) as defined by the world heart federation criteria and 7 patients (0.4%) were diagnosed with adult congenital heart disease. Conclusion: Population-based studies and community engagement have become an increasingly prevalent means of improving health. BHS is among the first population studies in Egypt and the MENA region to focus on CVD . BHS provides a phenotypically well-characterized population, the preliminary results has shown a very high incidence of consanguinity, obesity, diabetes, dyslipidemia and hypertension. Future research integration of OMICs data and other determinants of health is essential to advancements in precision medicine, CVD understanding and prevention. It is anticipated that this ongoing study will yield valuable information for formulating healthcare policy.
Abstract P402: Lifestyle Management Empowered by Deep Transfer Learning of Biomechanical Dynamics
Authors: Kiirthanaa Gangadharan, Qingxue Zhang
Journal: Circulation (2023)

Lifestyle management is essential for many promising applications, like cardiac health monitoring and post-stroke rehabilitation. Biomechanical dynamics during human physical movements are therefore attracting more attentions towards real-time and long-term lifestyle management. However, one challenge in biomechanical dynamics analysis is how to detect diverse physical activity types. Even more challenging is, how to quickly tune a detection algorithm that can adapt easily to a new user, who has user-specific biomechanical dynamics. We proposed and developed a deep transfer learning algorithm that, not only detects the physical activity types with a deep neural network, but also transfers the similar knowledge from non-target users to the target user. The former effort enables the algorithm to analyze the complex biomechanical patterns effectively, and the latter effort minimizes the tuning time of the algorithm when it is used on a new user. Evaluated on a fifteen-subject database, with six physical activity types, the proposed deep transfer learning algorithm achieves a detection accuracy of 90%, 92%, and 94%, with 0%, 10%, and 50% of training data from the target user, respectively. The results demonstrate that, with the transferred knowledge only, the accuracy can already reach 90%, which can be further increased with additional turning effort using the target data. This study will greatly advance deep learning of biomechanical dynamics, and further the transfer learning approach for algorithm tuning effort minimization on the new user. This study will greatly benefit lifestyle management by leveraging deep intelligence.
Abstract P416: Higher Quality Diet is Associated With Lower Serum Levels of NT-proBNP
Authors: Ping Yang, Mary R Rooney, Amelia S Wallace, Hyunju Kim, Justin B Echouffo Tcheugui, John William McEvoy, Chiadi E Ndumele, Robert H Christenson, Elizabeth Selvin, Casey M Rebholz
Journal: Circulation (2023)

Introduction: N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is widely used as a diagnostic biomarker for heart failure. Higher diet quality is associated with lower risk of cardiovascular disease. However, the association between diet and subclinical cardiovascular disease, as assessed by biomarker concentrations, is less well-studied. Hypothesis: We hypothesized that higher diet quality, assessed by the Healthy Eating Index-2015 (HEI-2015), would be associated with lower serum levels of NT-proBNP. Methods: We included 9,782 adults from the National Health and Nutrition Examination Survey (NHANES), 1999-2004. The HEI-2015 ranges from 0 to 100, with higher scores indicating better diet quality, and was categorized into sex-specific quintiles. Weighted multivariable linear regression models were used to estimate associations between the overall HEI-2015 score as well as its 13 components and log-transformed NT-proBNP. Results: Among 9,782 participants, mean age was 45 years, 48% were men, and 72% were non-Hispanic White adults. After adjusting for sociodemographic characteristics, lifestyle factors, and medical history, persons in the highest HEI-2015 quintile had a 10.0% lower NT-proBNP level compared to those in the lowest HEI-2015 quintile (95% CI: -17.7% to -2.6%). There was a dose-response relationship between HEI-2015 and NT-proBNP ( Figure ). For each 1-unit higher sodium and added sugars score, NT-proBNP was lower by 7.7% and 6.8% respectively (95% CI: -13.8 % to -2.2%, and 95% CI: -13.1% to -0.9% respectively). Conclusion: Higher diet quality, especially lower intakes of sodium and added sugars, was associated with lower serum levels of NT-proBNP.
Abstract P408: Association Between South Asian Ethnicity and Clinical Characteristics of Patients Undergoing Cardiac Catheterization
Authors: Aayush Visaria, Naveena Yanamala, Seung Jae Moon, Payal Dave, Ranita Sharma
Journal: Circulation (2023)

Background: We sought to describe differences in the characteristics of coronary interventions in U.S. South Asians (SA), an ethnicity at high risk for CAD, as compared to other races/ethnicities in New Jersey. Methods: In this single-center, retrospective cohort study of 8,850 patients from 2019-2021 undergoing coronary interventions (elective or acute), SAs were identified by 2 expert adjudicators. We used multivariable linear regression to estimate differences in mean age of coronary intervention by race/ethnicity (SA, non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic, Other Asian, Other/unspecified). Among a subset of 7,288 patients, we used logistic regression to estimate odds of premature CAD (age&lt;50y for overall cohort, &lt;45y for male, &lt;55y for female) and odds of multi-vessel disease (MVD; &gt;2 vessels with ≥70% stenosis), adjusted for confounders (Table). Results: Among 8,850 patients (mean age 68y; 34% female; 5,011 [58%] NHW, 1,054 [12%] SA), 8.6% had premature CAD, 38% had acute coronary syndrome, and 20% had MVD. SA males, on average, were 5.1y younger and SA females were 3.9y younger, than NHW (male: SA, 63y [SD,12], 67[11] for NHW; female: SA, 67[11], NHW, 70[12]. p&lt;0.001). Compared to NHW, SAs had 4.0x higher odds (male: 4.6x, female: 2.1x), NHB had 2.6x higher odds (M: 2.7x, F: 2.3x), other Asians had 2.1x higher odds (M: 2.3x, F: 1.3x), and Hispanics had 4.5x higher odds (M: 5.4x, F: 2.5x) of premature CAD (Table). SAs also had 47% higher odds of MVD than NHW (male: 45%, female: 47%), while NHB and Hispanics had 46% and 24% lower odds, respectively (Table). Findings were similar when restricting the cohort to patients requiring acute intervention (SA vs. NHW; OR [95% CI]. premature CAD, 3.73[2.44,5.71]; MVD, 1.54[1.12,2.11]). Conclusion: Independent of CAD risk factors, NJ SA males and females undergoing coronary intervention have more than 4 times and 2 times the likelihood of premature CAD, respectively, and more than 1.4 times the likelihood of multi-vessel disease compared to NHW.
Abstract P515: HIV/HCV Co-Infection and the Risk of Cardiovascular Disease: A Meta-Analysis of 91,153 Patients
Authors: Ahmed Aljabali, Sarya Swed, Bisher Sawaf, Basel Abdelazeem
Journal: Circulation (2023)

Introduction: Antiretroviral therapy has improved the life expectancy of people living with human immunodeficiency virus (HIV). However, these patients are more susceptible to developing cardiovascular diseases (CVD) and subsequent mortalities. Many studies examining the association between HIV and hepatitis C virus (HCV) co-infection and the risk of CVD, compared to HIV mono-infection, have inconsistent results. We conducted a meta-analysis to quantify this association. We hypothesized that CVD risk will be synergistically increased by the persistent inflammatory responses of dual viral infections. Method: We searched Pubmed, EMBASE, CINAHL, Google Scholar, Cochrane, and Web of Science from inception to July 2022 to identify studies on HIV/HCV co-infection and CVD, defined as coronary artery disease, congestive heart failure, and stroke. We used either a random or fixed effect model considering the heterogeneity. Adjusted hazard ratios (aHR) and crude Odds ratio (COR) for CVD and mortality were used. Results: Among the 453 articles reviewed, 11 observational studies met the inclusion criteria, with a total of 91,153 participants. Of these, 9633 (10.5%) were HIV/HCV coinfected, 81,520 (89.5%) were HIV monoinfected. Pooled hazard ratio for the association between HIV/HCV co-infection and CVD was significant (aHR = 1.45, 95% CI: 1.24, 1.65, I2 = 38%, P=0.12) compared to HIV mono-infection. Furthermore, the odds of mortality due to HIV/HCV co-infection in patients with CVD is significantly higher compared to HIV mono-infection (COR = 4.07, 95% CI: 3.19, 5.18, I2 = 0%, P=0.56). Conclusion: We found a positive association between HIV/HCV coinfection and increased CVD risk and associated mortality compared to those with HIV mono-infection. However, more research is needed for further assessment of this association, determining potential underlying mechanisms and evaluating whether treatment for HIV and HCV infections can reduce CVD morbidities and mortalities.